Health Care Reform in States

By Mary Branham, CSG Managing Editor

States don’t have to wait on the federal government for health care reform. Many, in fact, are already headed in that direction.

Vermont health officials last week shared their Blueprint for Health — the efforts the state is making to improve access and coverage as well as quality of health care — during the annual meeting of the Eastern Regional Conference of The Council of State Governments.

Jim Hester, director of the Health Care Reform Commission for the Vermont State Legislature, said in considering ways to reduce the number of the state’s uninsured, officials wanted to ensure the effort would be sustainable.

“We didn’t want to have improvements in coverage and then not be able to sustain it,” he said.

Vermont’s health reform efforts also focused on developing a statewide improvement plan for care of chronic illness, as well as prevention of chronic illness.

“If you want to change the results your system gets, you have to change the design of the system,” said Hester.

But that’s not easy on a statewide level, he said. Vermont started at the local level, using three enhanced pilot projects in communities that include 10 percent of the state’s population.

Sen. Jane Kitchel, co-chair of the state’s Senate Health Care Reform Committee, said states face many challenges in their efforts. Among them are unrelenting increases in health care costs, budget shortfalls, a shortage of primary care practitioners and the lack of involvement from Medicare and other federal payers.

Federal reform efforts include expanding Medicaid, and asking states to pick up part of the tab. That could have a major impact on state budgets.

Under some proposed federal plans, about 11 million more people — including adults without children — could be added to states’ Medicaid rolls, making it harder for states to afford their Medicaid payments, said Chris Whatley, director of The Council of State Governments’ Washington, D.C., office. About 47 million Americans don’t have health insurance.

Whatley pointed out that the health care bill under consideration in the U.S. Senate could have the greatest financial wallop on states.

The federal government is trying to find ways to trim cost from its proposed health care plans and “the way you do that is, you throw states under the bus, unfortunately,” he said.

Dr. David Newman, director of clinical research at St. Luke Roosevelt Hospital and an associate professor at Columbia University, offered policymakers some advice on making decisions related to health care during the ERC meeting.

“Health care is in shambles in this country,” he told policymakers. “We need you to help us get back on the right track.”

That means making decisions related to health care coverage based on scientific evidence and not on observation, he said.

“Science is the truth that lasts,” he said. “Everything else is pseudo truth.”